Extra cost of NHS changes challenged: Nicholas Timmins reports that 30,000 new posts have brought no obvious care benefits

PRESSURE on health ministers to justify the extra costs of the National Health Service market mounted yesterday when a health authority chairman broke ranks to say there was no evidence that more patients had been treated as a result.

Ivan Lester, chairman of Harrogate NHS Trust, said the new style health service had produced an enormous increase in bureaucracy and transaction costs and he called for a proper study to see whether the changes have been worthwhile.

His call came as Department of Health figures out this week showed a 30,000 increase in managers and clerical and administrative staff since 1989, the year before the changes, and after John Redwood, Secretary of State for Wales, implied the NHS there had been overrun by 'men in grey suits'.

Mr Lester, who retires this month as a trust chairman after 15 years on health authorities, said: 'We have put in all these extra layers of bureaucracy and management and we do not actually know if we are getting any more health care out of this so-called market over and above the costs of running it.'

As a trust, he said, 'we now have managers to negotiate with the new managers appointed by the health authority over contracts. We have accountants to negotiate and agree with their newly appointed accountants . . . We have marketing people that we never had and we have people looking especially at quality while the health authority has people monitoring what our people are doing in the field of quality'.

Extra staff amounted to about half a dozen in his trust, but each was mirrored by matching managers in the health authorities. GP fund-holders had taken on extra staff. 'It is time to find out whether it is all worth it,' and at the moment, 'the jury is out'.

Mr Lester said it was plain that more patients had been treated and hospitals had been run more efficiently since the reforms. What was not clear was whether the extra costs of contracting for care had been worthwhile.

Sir Duncan Nichol, NHS chief executive, yesterday said it was 'pretty clear' they had been. 'We are doing more work than we ever did before at a higher level of efficiency with shorter waiting times for patients,' he said.

However, Chris Ham, Professor of Health Policy at the University of Birmingham, said while there had been increases in productivity 'what is impossible to disentangle is whether the increase in management costs has produced these benefits for patients, or whether it is mainly due to the more generous funding provided for the NHS around the time of the election'.

Last week, Andrew Foster, controller of the Audit Commission, told a conference there were 'very legitimate questions' to be asked about whether the NHS was getting value for money from the changes.

David Blunkett, Labour's health spokesman, said yesterday he was writing to the Audit Commission to ask it formally to carry out a study.

Sir Duncan said regional health authorities had been slimmed from an average 570 staff to 200, and more jobs will go when the 14 regions become eight regional offices. Department figures show that up to April pounds 366m was spent on management to introduce reforms.

Cut in doctors' night visits, page 4

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